Provider Demographics
NPI:1821415258
Name:RUSK COUNTY PHARMACY, INC
Entity type:Organization
Organization Name:RUSK COUNTY PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:J
Authorized Official - Last Name:PROHASKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-415-1891
Mailing Address - Street 1:312 W 9TH ST N
Mailing Address - Street 2:
Mailing Address - City:LADYSMITH
Mailing Address - State:WI
Mailing Address - Zip Code:54848-1269
Mailing Address - Country:US
Mailing Address - Phone:715-532-3339
Mailing Address - Fax:715-532-3330
Practice Address - Street 1:312 W 9TH ST N
Practice Address - Street 2:
Practice Address - City:LADYSMITH
Practice Address - State:WI
Practice Address - Zip Code:54848-1269
Practice Address - Country:US
Practice Address - Phone:715-532-3339
Practice Address - Fax:715-532-3330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-24
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X
WI9251-423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI10092-42OtherWI STATE PHARMACY LICENSE
WI7194160001Medicare NSC